Tuesday, January 26, 2016

Medicare CPT code G0444, 99420 - covered ICD and frequency

Depression Screening HCPCS/CPT Codes

G0444 – Annual depression screening, 15 minutes

ICD-10-CM Codes

See https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html for individual Change Requests (CRs) and coding translations for ICD-10

Who Is Covered

All Medicare beneficiaries

Must be furnished in a primary care setting that has staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up

Frequency

Annually

Beneficiary Pays

• Copayment/coinsurance waived
• Deductible waived


Medicare contractors will recognize new Healthcare Common Procedure Coding System (HCPCS) code, G0444, annual depression  screening, 15 minutes, as acovered service.

Background

Among persons older than 65 years, one in six suffers from depression. Depression in older adults is estimated to occur in 25% of those with other illness including cancer, arthritis, stroke, chronic lung disease, and cardiovascular disease. Other stressful events, such as the loss of friends and loved ones, are also risk factors for depression. Opportunities are missed to improve health outcomes when mental illness is under-recognized and under-treated in primary care settings.

Older adults have the highest risk of suicide of all age groups. These patients are important in the primary care setting because 50-75% of older adults who commit suicide saw their medical doctor during the prior month for general medical care, and 39% were seen during the week prior to their death. Symptoms of major depression that are felt nearly every day include, but are not limited to, feeling sad or empty; less interest in daily activities; weight loss or gain when not dieting; less ability to think or concentrate; tearfulness, feelings of worthlessness, and thoughts of death or suicide.

Section1861(ddd) of the Social Security Act permits the Centers for Medicare & Medicaid Services (CMS) to add coverage of "additional preventive services" through the National Coverage Determination (NCD) process if all of the following criteria are met:

• Reasonable and necessary for the prevention or early detection of illness or disability;

• Recommended with a grade of A or B by the United States Preventive Services Task Force (USPSTF); and,

• Appropriate for individuals entitled to benefits under Part A or enrolled under Part

B. Screening for depression in adults is recommended with a grade of B by the USPSTF. The CMS reviewed the USPSTF recommendations and supporting evidence for screening depression in adults preventive services and determined that the criteria listed above was met, enabling the CMS to cover these preventive services.

Thus, effective October 14, 2011, Medicare covers annual screening for adults for depression in a primary care setting, as defined below, that has staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up. For the purposes of this NCD:

• A primary care setting is defined as one in which there is provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Emergency departments, inpatient hospital settings, Ambulatory Surgical Centers (ASCs), independent diagnostic testing facilities, Skilled Nursing Facilities (SNFs), inpatient rehabilitation facilities, and hospice are not considered primary care settings under this definition.

• Effective for claims with dates of service on and after April 2, 2012, contractors shall pay for annual depression screening claims, G0444, only when services are provided at the following Places of Service (POS):

o 11 - Office
o 22 - Outpatient hospital
o 49 - Independent clinic
o 71 - State or local public health clinic

• At a minimum level, staff-assisted depression care supports consist of clinical staff (e.g., nurse, Physician Assistant) in the primary care office who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment. More comprehensive care supports include a case manager working with the primary care physician;  planned collaborative care between the primary care provider and mental health clinicians; patient education and support for patient self-management; plus attention to patient preferences regarding counseling, medications, and referral to mental health professionals with or without continuing involvement by the patient’s primary care physician.

• Note: Coverage is limited to screening services and does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combination therapy (counseling and medications), or other interventions for depression. Self-help materials, telephone calls, and web-based counseling are not separately reimbursable by Medicare and are not part of this NCD.

• Screening for depression is non-covered when performed more than one time in a 12-month period. Eleven full months must elapse following the month in which the last annual depression screening took place. Medicare coinsurance and Part B deductible are waived for this preventive service.


Major Depressive Disorder in Children and Adolescents (Screening) 

Procedure Code(s): 99420, G0444

Diagnosis Code(s): (Required for 99420 only)

• ICD-9: V79.0

• ICD-10: Z13.89

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